Bladder inhibition by penile nerve stimulation in spinal cord injury patients.

Detrusor hyperreflexia causing voiding dysfunction in spinal cord injury patients is a difficult problem and is not always treated effectively by anticholinergic agents. We have been investigating electrical stimulation methods to inhibit hyperreflexia and dorsal penile nerve stimulation is the most promising. Six chronic suprasacral spinal cord injury men (average age 36 years) underwent stimulation testing with water cystometry before, during and after stimulation. Dorsal penile stimulation was done with carbon rubber butterfly electrodes (Medtronic) with parameters of 5 pulses per second, 0.35 msec. pulse duration, and current at a level above the threshold for pelvic twitching activity and adjusted for optimal bladder effect (range 25 to 70 mamp.). In all 6 patients the cystometrogram during stimulation showed an increase in bladder volume over the prestimulation cystometrogram (range 27 to 150%). In 2 patients there was no detrusor activity after filling to 500 cc. Stimulation was then stopped and a spontaneous contraction occurred. The cystometrogram conducted after the stimulus also had less volume than that performed during stimulation but it was larger than the prestimulation volume. Penile nerve stimulation was painless with no side effects. Penile nerve electrical stimulation is effective for inhibiting bladder hyperreflexia and should be easily adaptable for chronic home use as an alternative to current therapy.

[1]  M. Fall,et al.  Effects of electrical intravaginal stimulation on bladder volume: an experimental and clinical study. , 1978, Urologia internationalis.

[2]  R. J. Milne,et al.  Parasympathetic preganglionic neurons in the sacral spinal cord. , 1982, Journal of the autonomic nervous system.

[3]  R. Anderson,et al.  Urodynamic patterns after acute spinal cord injury: association with bladder trabeculation in male patients. , 1983, The Journal of urology.

[4]  E. McGuire,et al.  Detrusor-sphincter dyssynergia. , 1979, The Journal of urology.

[5]  M. Fall.  Reflex mechanisms for bladder inhibition. , 2009, Acta pharmacologica et toxicologica.

[6]  W. C. Groat.  Nervous control of the urinary bladder of the cat , 1975, Brain Research.

[7]  E. McGuire,et al.  Urodynamics and management of the neuropathic bladder in spinal cord injury patients. , 1985, The Journal of the American Paraplegia Society.

[8]  E. McGuire,et al.  Control of reflex detrusor activity in normal and spinal injured non-human primates. , 1983, The Journal of urology.

[9]  Teague Ct,et al.  Electric pelvic floor stimulation. Mechanism of action. , 1977 .

[10]  R. Hackler.  A 25-year prospective mortality study in the spinal cord injured patient: comparison with the long-term living paraplegic. , 1977, The Journal of urology.

[11]  G. Ayala,et al.  Bladder inhibition with functional electrical stimulation. , 1975, Urology.

[12]  M. Nakamura,et al.  Bladder inhibition by penile electrical stimulation. , 1984, British journal of urology.

[13]  Richard A. Schmidt,et al.  Applications of neurostimulation in urology , 1988 .

[14]  D. Vodušek,et al.  Detrusor inhibition induced by stimulation of pudendal nerve afferents , 1986 .

[15]  Stanislav Plevnik,et al.  Maximal electrical stimulation for urinary incontinence , 1979 .

[16]  Stanislav Plevnik,et al.  Detrusor inhibition on selective pudendal nerve stimulation in the perineum , 1987 .

[17]  W. D. de Groat,et al.  Neural control of the urinary bladder: Possible relationship between peptidergic inhibitory mechanisms and detrusor instability , 1985 .